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Atallah O, Badary A, El-Ghandour NMF, Almealawy YF, Wireko AA, Syrmos N, Umana GE, Al-Barbarawi M, Ergen A, Shrestha P, Chaurasia B. Cystic dilatation of the ventriculus terminalis: A narrative review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:319-329. [PMID: 38268679 PMCID: PMC10805159 DOI: 10.4103/jcvjs.jcvjs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Yasser F. Almealawy
- Department of Neurosurgery, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | - Andrew Awuah Wireko
- Department of Neurosurgery, Faculty of Medicine, Sumy State University, Sumy, Ukraine
| | - Nikolaos Syrmos
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Centre, Gamma Knief Centre, Cannizzaro Hospital, Catania, Italy
| | | | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Derince, Kocaeli, Turkey
| | - Prabin Shrestha
- Department of Neurosurgery, Kathmandu Neuro and General Hospital, Kathmandu, Nepal
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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2
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Dasic D, Signorelli F, Ligarotti GKI, D'Onofrio GF, Rapisarda A, Syrmos N, Chibbaro S, Visocchi M, Ganau M. Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011-2021. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:399-404. [PMID: 38153500 DOI: 10.1007/978-3-031-36084-8_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The literature features limited evidence on the natural history of the cystic dilatation of the ventriculus terminalis (CDVT) and its response to treatment. The goal of this study is to ascertain which impact the revised operative classification of CDVT had on the management of patients diagnosed over the past 10 years.Ten new clinical articles presenting a total of 30 cases of CDVT were identified and included for qualitative analysis. Two take-home messages can be identified: (1) Adequate consideration should be given to designing national pathways for referral to tertiary centers with relevant expertise in the management of lesions of the conus medullaris, and (2) we suggest that type Ia should be, at least initially, treated conservatively, whereas we reckon that the signs and symptoms described in types Ib, II, and III seem to benefit, although in some patients only partially, from surgical decompression in the form of cystic fenestration, cyst-subarachnoid shunting, or both.While the level of evidence gathered in this systematic review remains low because the literature on CDVT consists only of retrospective studies based on single-center series (level of evidence 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM)), the strength of recommendation for adopting the revised operative classification of CDVT is moderate.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Salvatore Chibbaro
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Mario Ganau
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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3
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D'Onofrio GF, Rapisarda A, Signorelli F, Ganau M, Chibbaro S, Montano N, Polli FM, Visocchi M. Toward the End of the Funnel: The Ventriculus Terminalis-The State of Art of an Ancient Entity with a Recent History. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:395-397. [PMID: 38153499 DOI: 10.1007/978-3-031-36084-8_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE The ventriculus terminalis (VT), also called the fifth ventricle, is a small cavity containing cerebrospinal fluid (CSF) that is in the conus medullaris in continuity with the central canal of the spinal cord. In adults, persistent VT is a very rare entity, and the diagnosis is incidental in most cases. Rarely, VT may become symptomatic for still-uncertain reasons but most often for its cystic dilatation. The management of these selected cases is still controversial and sometimes associated with unsatisfactory outcomes. METHODS We performed a critical review of the existing literature on the management of symptomatic VT in adults. The etiology, pathophysiology, and treatment of VT are presented and discussed, focusing on the best timing for surgery. RESULTS Conservative management, marsupialization, or the placement of a T drain have been reported. The existing classifications describe the most correct approach for each clinical presentation, but scarce importance has been given to the delay from symptoms' onset to surgical treatment. CONCLUSION Although different cases have been described in the literature, this rare pathology remains unknown to most neurosurgeons.
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Affiliation(s)
| | - Alessandro Rapisarda
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Francesco Signorelli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nicola Montano
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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4
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Núñez Báez SG, De Jesus O, Labat EJ, Feliciano CE. Ventriculus terminalis or conus medullaris arachnoid cyst: a diagnostic dilemma. BMJ Case Rep 2022; 15:e250812. [PMID: 35623655 PMCID: PMC9150153 DOI: 10.1136/bcr-2022-250812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sergio G Núñez Báez
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Caleb E Feliciano
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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5
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Baig Mirza A, Visagan R, Boardman T, Murphy C, Al-Ali B, Kellett C, Grahovac G. Recurrent terminal ventricle cyst: a case report. J Surg Case Rep 2021; 2021:rjab498. [PMID: 34804483 PMCID: PMC8598984 DOI: 10.1093/jscr/rjab498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
The terminal ventricle (TV) of Krause is a rare cystic dilation of the conus' central canal. Due to limited understanding surrounding its pathophysiology, optimal management remains controversial. We report a 25-year-old female presenting with acute paraparesis. Magnetic resonance imaging spine revealed a cystic conus medullaris lesion in keeping with an incidental TV cyst. However, the patient experienced a rapid resolution of symptoms. We hypothesize that the TV cyst spontaneously ruptured and auto-decompressed. To our knowledge, this is the first reported case of an enlarging symptomatic TV cyst with spontaneous rupture and resolution of symptoms, highlighting the variable natural history of this condition.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ravindran Visagan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Boardman
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Murphy
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Bilal Al-Ali
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Kellett
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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6
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Abstract
Ventriculus terminalis (VT) is a cystic embryological remnant within the conus medullaris that normally regresses after birth. In rare cases, it may persist into adulthood and give rise to neurologic symptoms. The pathogenesis remains unclear but is thought to be related to failed embryonic regression with other proposed possible etiologies including vascular disturbances. We present an intriguing case of a slow-growing VT in a woman with progressive neurologic symptoms who experiences symptomatic relief following thoracic laminectomy and fenestration. Our case is the first to present a unique association with polyarteritis nodosa and only the third to report a case of documented enlargement of the VT over time successfully treated with surgical fenestration.
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Affiliation(s)
- Luke J Weisbrod
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Collin Liu
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Daniel Surdell
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA.,Neurosurgery, University of Nebraska Medical Center, Omaha, USA
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7
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T10-L3 Cystic Lesion of the Ventriculus Terminalis Presenting as Conus Medullaris Syndrome. World Neurosurg 2020; 136:146-149. [DOI: 10.1016/j.wneu.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/17/2022]
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8
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Fletcher-Sandersjöö A, Edström E, Bartek J, Elmi-Terander A. Surgical treatment for symptomatic ventriculus terminalis: case series and a literature review. Acta Neurochir (Wien) 2019; 161:1901-1908. [PMID: 31278597 PMCID: PMC6704110 DOI: 10.1007/s00701-019-03996-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ventriculus terminalis is a cystic embryological remnant within the conus medullaris that normally regresses after birth. In rare cases, it may persist into adulthood and give rise to neurological symptoms, for which the optimal treatment remains uncertain. The aim of this study was to present our experience from a population-based cohort of patients with ventriculus terminalis and discuss our management strategy as compared to the existing literature. METHODS A retrospective review was conducted of all adult (≥ 15 years) patients with ventriculus terminalis who were referred to the Karolinska University Hospital between 2010 and 2018. RESULTS Fourteen patients were included. All patients were symptomatic at the time of referral, and the most common symptom was lower limb weakness (n = 9). Microsurgical cyst fenestration was offered to all patients and performed in thirteen. Postoperative imaging confirmed cyst size reduction in all surgically treated patients. No surgical complications were reported. Eleven of the surgically treated patients showed clinical improvement at long-term follow-up. One patient declined surgery, with progression of the cyst size and clinical deterioration observed at follow-up. CONCLUSIONS Surgery for ventriculus terminalis seems to be a safe and effective option for relief of symptoms. We propose that surgery should be offered to all patients with symptomatic ventriculus terminalis.
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Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden.
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
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9
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Maj E, Wójtowicz K, Aleksandra, Podlecka-Piȩtowska, Prokopienko M, Marchel A, Rowiński O, Bekiesińska-Figatowska M. Intramedullary spinal tumor-like lesions. Acta Radiol 2019; 60:994-1010. [PMID: 30537844 DOI: 10.1177/0284185118809540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of magnetic resonance imaging (MRI) has led to an increasingly frequent detection of changes in the spinal cord. The most common intramedullary lesions are: demyelinating; vascular; inflammatory; infectious; and congenital, largely called tumor-like lesions. Spinal cord tumors are relatively rare, as compared with brain tumors. The hardest task is to conclude whether the spinal cord lesion is a tumor or a tumor-like lesion. This review is intended to help evaluate the spinal cord and gives an overview of the tumor-like lesions occurring in the spinal cord along with their characteristic.
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Affiliation(s)
- Edyta Maj
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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10
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Panwar N, Purohit DK, Sharma S, Chopra S. Symptomatic Thoracic Intramedullary Arachnoid Cyst: "A Rare Entity" Report of Two Cases with Short Review of Literature. J Neurosci Rural Pract 2019; 10:306-311. [PMID: 31001022 PMCID: PMC6454973 DOI: 10.4103/jnrp.jnrp_246_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Spinal arachnoid cysts are uncommon benign lesions of spine axis and most commonly present as compressive myelopathy. Intramedullary arachnoid cyst is uncommonly seen, hence, not much discussed in literature. Due to rarity of this entity, many questions are yet to be answered and should be addressed properly, particularly related to etiopathogenesis, accustomed course, behavior, differential diagnosis, and the best treatment modality. We report the clinicopathological profile of thoracic intramedullary arachnoid cysts in two adult patients, and present a detailed review of available literature on the spinal intramedullary arachnoid cyst. Most of the literature concerning with intramedullary arachnoid cysts are in the form of case reports from pediatrics population. As far to the best of our knowledge, only a few cases excluding our two were found in both pediatrics and adult population.
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Affiliation(s)
- Naresh Panwar
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Somnath Sharma
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Sanjeev Chopra
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
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11
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Hiremath SB, Boto J, Regnaud A, Etienne L, Fitsiori A, Vargas MI. Incidentalomas in Spine and Spinal Cord Imaging. Clin Neuroradiol 2019; 29:191-213. [PMID: 30887091 DOI: 10.1007/s00062-019-00773-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
Incidentalomas are common in magnetic resonance imaging (MRI) of the spine. These incidental findings (IFs) can be seen involving the spinal cord, nerve root, vertebral body, posterior arch and the extraspinal region. This review article describes the imaging findings, stratifies the IFs similar to the computed tomography (CT) colonography reporting and data system and briefly mentions the current recommendations for further evaluation and management of IFs. Radiologists are the first to detect these lesions, suggest further evaluation and management of IFs. It is therefore mandatory for them to be aware of recommendations in clinical practice in order to avoid increased patient anxiety, excessive healthcare expenditure and inadvertent therapeutic procedures.
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Affiliation(s)
- Shivaprakash B Hiremath
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - José Boto
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Alice Regnaud
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Léonard Etienne
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Aikaterini Fitsiori
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland.
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12
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Lotfinia I, Mahdkhah A. The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports and a literature review. J Spinal Cord Med 2018; 41:741-747. [PMID: 29791269 PMCID: PMC6217512 DOI: 10.1080/10790268.2018.1474680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
CONTEXT The ventriculus terminalis (VT) is a very small ependymal-lined residual lumen in the conus medullaris. It is normally present in all subjects during fetal development. VT in adults appears as an unusual pathology with an uncertain pathogenesis. FINDINGS In this paper, we described three case reports of symptomatic fifth ventricle cystic dilations. All of them were female and their mean age was 59 years. We treated them surgically and all three patients were improved based on clinical and imaging assessments. CONCLUSION Our cases suggested that surgical decompression was a safe and effective treatment in symptomatic patients and the neurosurgeons should be aware of such rare situations. A complete list of differential diagnosis about other cystic dilations of the conus medullaris should be emphasized to select the correct clinical approach.
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Affiliation(s)
- Iraj Lotfinia
- Professor of Neurosurgery Department of Neurosurgery, Tabriz University of Medical Science, Tabriz, Iran
| | - Ata Mahdkhah
- Assistant Professor of Neurosurgery Department of Neurosurgery, Urmia University of Medical Science, Urmia, Iran
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13
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Mottet N, Chaussy Y, Auber F, Guimiot F, Arbez-Gindre F, Riethmuller D, Cretolle C, Benachi A. How to Explore Fetal Sacral Agenesis Without Open Dysraphism: Key Prenatal Imaging and Clinical Implications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1807-1820. [PMID: 29377253 DOI: 10.1002/jum.14522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
The estimated prevalence of fetal caudal dysgenesis is 1 per 100,000 births. The functional prognosis of sacral agenesis is dominated by the large spectrum of associated caudal malformations. Except for cases associated with hydrocephalus secondary to open spinal dysraphism or chromosomal anomalies, association with mental deficiency is rare. We propose a systematic prenatal approach to cases of fetal sacral agenesis based on 9 etiologic items: clinical context, type of sacral dysgenesis, associated spinal cord malformations, mobility of lower limbs, investigation of the presacral region, analysis of the gastrointestinal tract, analysis of the genitourinary tract, associated vertebral defects, and cytogenetic analysis.
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Affiliation(s)
- Nicolas Mottet
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Yann Chaussy
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Frederic Auber
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Fabien Guimiot
- Department of Developmental Biology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Denis Diderot University, Paris, France
| | - Francine Arbez-Gindre
- Unit of Fetal Pathology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Didier Riethmuller
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Célia Cretolle
- National Reference Centre for Rare Diseases on Anorectal Malformations and Rare Pelvic Anomalies, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
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14
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Severino R, Severino P. Surgery or not? A case of ventriculus terminalis in an adult patient. JOURNAL OF SPINE SURGERY 2017; 3:475-480. [PMID: 29057360 DOI: 10.21037/jss.2017.06.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ventriculus terminalis (VT) is an intramedullary cavity containing cerebrospinal fluid (CSF), usually located at the conus, and represents an unsuccessful regression of a normal embryological phase of the development of the neural tube. Symptoms are not univocal and may vary from aspecific signs to sphincter dysfunctions and focal neurological deficits. The correct management of this condition is still an object of debate due to its rarity and its unpredictable behaviour in adult patients. Two different studies have proposed a distinction for patients with cystic dilatation of VT based on their symptoms, suggesting that only those patients with neurological deficits clearly related to the terminal ventricle could benefit from surgery. We describe a case of an adult patient with a progressive dilatation of a diagnosed VT that we treated surgically. A management flowchart for this condition is also proposed based on our experience and a review of the literature.
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Affiliation(s)
- Rocco Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy
| | - Paolo Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy
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15
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Zeinali M, Safari H, Rasras S, Bahrami R, Arjipour M, Ostadrahimi N. Cystic dilation of a ventriculus terminalis. Case report and review of the literature. Br J Neurosurg 2017; 33:294-298. [PMID: 28618974 DOI: 10.1080/02688697.2017.1340585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the spinal cord. Cystic dilatation of the ventriculus terminalis on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. VT has been described in children as a normal developmental phenomenon. These lesions are often diagnosed incidentally during imaging and are in most cases asymptomatic, especially in children. Symptomatic dilatation of VT in adults is a rare condition with 61cases being reported to date. Symptomatic dilatation of VT in children has not been reported till now. We present a 5 year-old-boy with a sphincteric and walking disorder. The patient was assessed by clinical, electrophysiological and urodynamic investigations as well as magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement. Lumbar-sacral MRI demonstrated the presence of a cystic lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the ventriculus terminalis dilation.The patient underwent laminectomy and the cyst wall was fenestrated with a midline myelotomy. In 6-month of follow-up, urinary problems and gait disturbance improved.
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Affiliation(s)
- Masoud Zeinali
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Hosein Safari
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Saleh Rasras
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Reza Bahrami
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Mahdi Arjipour
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Nima Ostadrahimi
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
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16
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Zhang L, Zhang Z, Yang W, Jia W, Xu Y, Yang J. Cystic Dilation of the Ventriculus Terminalis: Report of 6 Surgical Cases Treated with Cyst-Subarachnoid Shunting Using a T-Catheter. World Neurosurg 2017; 104:522-527. [PMID: 28512052 DOI: 10.1016/j.wneu.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cystic dilation of the ventriculus terminalis (CDVT) is a rare anatomic variation that and may become symptomatic. Literature regarding CDVT is limited, and thus the clinical characteristics and management strategy of CDVT are unclear. Here we report 6 cases of CDVT seen in our institution, and provide a review of the current literature. METHODS The study cohort comprised 6 patients with CDVT seen at Beijing Tiantan Hospital between September 2010 and June 2015. All 6 patients were managed surgically. Data on age, sex, clinical presentation, radiologic features, operative methods, and surgical outcomes were reviewed retrospectively. We evaluated the clinical outcomes and postoperative radiologic changes of these patients and compared them with findings of similar previous reports. RESULTS All 6 patients were female, with a median age of 50.0 years (interquartile range [IQR], 25.8-54.0 years). Surgical management of cyst-subarachnoid shunting using T-catheter after myelotomy was successfully performed in all patients. During an average follow-up of 41 months, relief of clinical symptoms, especially low-back pain and sciatica, were observed in all 6 patients. No patients experienced symptom recurrence during follow-up, and postoperative magnetic resonance imaging revealed no regrowth of the lesion. Patients with focal neurologic deficits and sphincter disorders also achieved symptom relief from the procedure. CONCLUSIONS CDVT is an extremely rare cause of conus medullaris syndrome with an unclear treatment strategy. Our successful surgical management of 6 cases through cystic-subarachnoid shunting using a T-catheter for CDVT drainage provides a potential option for treating CDVT.
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Affiliation(s)
- Liang Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Zhifeng Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wenqing Jia
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China.
| | - Yulun Xu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Jun Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
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Woodley-Cook J, Konieczny M, Spears J. The Slowly Enlarging Ventriculus Terminalis. Pol J Radiol 2016; 81:529-531. [PMID: 27867442 PMCID: PMC5102252 DOI: 10.12659/pjr.895669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 04/24/2016] [Indexed: 11/09/2022] Open
Abstract
Background A cerebral spinal fluid (CSF) cavity within the conus medullaris has been described by the term ventriculus terminalis (VT) or the fifth ventricle. The finding of a VT on MRI imaging of the lumbar spine is often incidental but may be found in patients with low back pain or neuromuscular deficits. These lesions, when identified, are thought to regress or remain stable in terms of size, although some have been described to enlarge in the presence of post-traumatic meningeal hemorrhages or deformities of the vertebral canal. Case Report We describe a case of a slowly growing VT in a patient with progressing lower limb weakness without any history or imaging findings of trauma or spinal canal abnormalities. Conclusions We present an intriguing case of a slowly growing VT in a woman with progressive neurological symptoms. Surgical fenestration provided complete symptomatic relief and follow-up imaging two years after surgery demonstrated no evidence of recurrence. This, to our knowledge, is the first described case of a slowly enlarging VT independent of any other imaging findings.
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Affiliation(s)
- Joel Woodley-Cook
- Department of Diagnostic Imaging, The Scarborough Hospital, Scarbrorough, ON, Canada
| | - Magdalena Konieczny
- Department of Diagnostic Imaging, The Scarborough Hospital, Scarbrorough, ON, Canada
| | - Julian Spears
- Department of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
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18
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Schwartz C, Lutz J, Romagna A, Tonn JC, Zausinger S, Schöller K. Microsurgical fenestration of idiopathic intramedullary cysts in adult patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:968-74. [PMID: 24972982 DOI: 10.1007/s00586-014-3437-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/21/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to describe the findings in one of the largest series of microsurgically treated intramedullary cysts investigated by magnetic resonance imaging (MRI), focusing on the peri- and intraoperative setup including detailed neurological and radiological outcome analyses. METHODS Retrospective analysis of patients with intramedullary cyst who had undergone microsurgical fenestration at our department between 2006 and 2011. Preoperative three-dimensional constructive interference of steady-state MRI was conducted to optimize surgical planning. Intraoperative electrophysiological monitoring included motor-evoked potentials, somatosensory-evoked potentials, and electromyogram. Clinical outcome as well as pre-, postoperative and long-term MRI scans were evaluated. RESULTS Eight female patients (median age 58.0 years, range 32-72 years) with a median clinical follow-up of 48.0 months (range 2-69 months) were included. Seven cysts were located in the conus medullaris, one in the cervical spine. Overall, 25.0% (2/8) showed complete remission of preoperative symptoms, 62.5% (5/8) improved, and 12.5% (1/8) asymptomatic patients remained unchanged. Pain syndromes (4/4) as well as motor deficits (2/2) improved in all affected patients and bladder dysfunction (3/4) displayed a high tendency for improvement. Postoperative MRI scans showed permanently decreased cyst volumes by ~80%. CONCLUSION Microsurgical fenestration of intramedullary cysts using preoperative high-resolution imaging and intraoperative electrophysiological monitoring is a safe and effective treatment option for symptomatic patients.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany,
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Nishimura Y, Hara M, Natsume A, Nakajima Y, Fukuyama R, Wakabayashi T, Ginsberg HJ. Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina. J Neurosurg Spine 2013; 19:716-20. [DOI: 10.3171/2013.8.spine121012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12–L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected.
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Affiliation(s)
- Yusuke Nishimura
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Masahito Hara
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Atsushi Natsume
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | | | | | - Howard J. Ginsberg
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Bellocchi S, Vidale S, Casiraghi P, Arnaboldi M, Taborelli A. Multilobed cystic dilation of the ventriculus terminalis (CDVT). BMJ Case Rep 2013; 2013:bcr2013008654. [PMID: 23682083 PMCID: PMC3669794 DOI: 10.1136/bcr-2013-008654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The cystic dilation of ventriculus terminalis (CDVT) is a rare anatomical variant in adulthood. In this report we describe a new case of an adult with multilobed CDVT, causing low-back pain and subjective disturbances in walking. A myelotomy with fenestration of the cyst was performed with a good clinical and radiological outcome.
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Affiliation(s)
| | - Simone Vidale
- Department of Neurology, Sant'Anna Hospital, Como, Italy
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21
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Massive cystic dilatation within a tethered filum terminale causing cauda equina compression and mimicking syringomyelia in a young adult patient. Childs Nerv Syst 2013; 29:141-4. [PMID: 22961358 DOI: 10.1007/s00381-012-1911-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The ventriculus terminalis (VT) is formed during early embryonic development of the spinal cord and can only be identified histologically in both children and adults. Cystic dilatation of the VT can be seen in young children, but it rarely persists through adulthood. CLINICAL CASE We describe a 27-year-old female with paraparesis secondary to a massive and tethered cystic dilatation of the VT mimicking syringomyelia. Symptoms appearing in early childhood were ignored, probably leading to the much prominent presentation in early adulthood. The preoperative presentation and surgical treatment are discussed in relation to childhood history. CONCLUSIONS Although extremely rare, symptomatic dilatation of the VT can be seen in young adults, usually with previous manifestations in early childhood. This entity should be considered while treating tethered cord spectrum.
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22
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Suh SH, Chung TS, Lee SK, Cho YE, Kim KS. Ventriculus terminalis in adults: unusual magnetic resonance imaging features and review of the literature. Korean J Radiol 2012; 13:557-63. [PMID: 22977322 PMCID: PMC3435852 DOI: 10.3348/kjr.2012.13.5.557] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 03/29/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The ventriculus terminalis (VT) in adults is a rare pathology. We report various MR imaging features of the adult VT. MATERIALS AND METHODS Ten patients were included in this retrospective review.. All patients had undergone magnetic resonance (MR imaging with a surface coil that used two different 1.5T MR systems. All patients had undergone initial and follow-up MR imaging with contrast enhancement using gadopentate dimeglumine. Three patients underwent additional MR imaging using the echocardiogram-gated spatial modulation of magnetization (SPAMM) technique. If a shift in tagging band during the systolic phase was less than half of the band space, it was defined as a "non-pulsatile fluid". Two neuroradiologists independently reviewed these images, while clinical symptoms and outcomes were statistically analyzed between the treated and non-treated group. RESULTS All cases presented an intramedullary cystic lesion in the conus medullaris and showed the same signal intensity as CSF. Three VTs had intracystic septation and cord edema, which were pathologically confirmed after surgery; two of these were associated with kyphotic deformity and spinal arteriovenous malformation. SPAMM-MRI of 3 patients demonstrated non-pulsatile fluid motion within the VT. In the treated group, clinical symptoms improved better than the non-treated group. CONCLUSION The adult VT shows some unusual imaging features, including septation, cord edema, and coexistence of a spinal AVM, as well as the typical findings. Surgical maneuvers may be considered as a treatment option in adult VT with progressive neurological symptoms.
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Affiliation(s)
- Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
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23
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Ganau M, Talacchi A, Cecchi PC, Ghimenton C, Gerosa M, Faccioli F. Cystic dilation of the ventriculus terminalis. J Neurosurg Spine 2012; 17:86-92. [DOI: 10.3171/2012.4.spine11504] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The ventriculus terminalis, an embryological remnant consisting of the ependymal-lined space of the conus medullaris, can occasionally become symptomatic after cystic dilation. In the existing literature, consisting of 32 cases, the preferred type of management (conservative vs surgical) is still debated. The object of this study was to report the surgical results in a consecutive series of 10 adult patients with cystic dilation of the ventriculus terminalis (CDVT), to match them with data retrieved from the relevant literature, and specifically to validate a new recent clinical classification.
Methods
The authors reported 13 new cases of CDVT treated in the Department of Neurosurgery at University Hospital in Verona, Italy. Treatment modalities and clinical and radiological outcomes, both early and at follow-up, were analyzed and compared with a preoperative classification of clinical presentation, as established by de Moura Batista and colleagues (2008).
Results
Surgical treatment seemed to guarantee the resolution of CDVT. Dorsolumbar laminotomy, myelotomy, and cystic drainage were performed in 10 patients. Patients with Type I symptoms (nonspecific complaints) often presented with comorbidities (herniated disc or facet hypertrophy) confusing their clinical status. The surgical treatment of patients with Type I symptoms promoted good results only if the diagnosis of CDVT was definitive and symptoms had rapidly evolved. In patients with Type II (focal neurological deficits) and III (sphincter disturbances) symptoms, surgical treatment sustained improvement even at the late follow-up.
Conclusions
While confirming the usefulness of de Moura Batista and colleagues' classification in its impact on prognosis, the authors propose a revision of the classification with subgroups Type Ia (nonspecific symptoms without clear relation to CDVT), which is best treated conservatively, and Type Ib (rapid onset and invalidating unspecific complaints without comorbidities), which may benefit from surgical evacuation.
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Affiliation(s)
- Mario Ganau
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | - Andrea Talacchi
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | | | | | - Massimo Gerosa
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | - Franco Faccioli
- 4Department of Neurosurgery, University Hospital, Verona; and
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Dhillon R, McKelvie P, Wang Y, Han T, Murphy M. Cystic lesion of the ventriculus terminalis in an adult. J Clin Neurosci 2010; 17:1601-3. [DOI: 10.1016/j.jocn.2010.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/30/2010] [Accepted: 04/04/2010] [Indexed: 11/28/2022]
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Reply to ‘Comment on: “Ependymal cyst in the conus medullaris”. J Clin Neurosci 2010. [DOI: 10.1016/j.jocn.2010.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Carvalho CH, Acioly MA, Batista LM, Wirtz CR. Comment on: "ependymal cyst in the conus medullaris". J Clin Neurosci 2010; 17:1606; author reply 1606-7. [PMID: 20888235 DOI: 10.1016/j.jocn.2010.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/07/2010] [Indexed: 11/19/2022]
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Re: Percutaneous aspiration of spinal terminal ventricle cysts using real-time magnetic resonance imaging and navigation. Spine (Phila Pa 1976) 2009; 34:2595; author reply 2595-6. [PMID: 19927112 DOI: 10.1097/brs.0b013e3181b61d2f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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28
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Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev 2008; 32:287-300; discussion 300-1. [PMID: 18820958 DOI: 10.1007/s10143-008-0173-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 08/01/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.
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Affiliation(s)
- Florian H Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
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